Traditionally, face-lifts are performed by surgically cutting and removing portions of the skin. In the subcutaneous tissue layer, where the fat joins the dermis, there are few nerves and there are only occasional blood vessels connecting the fat to the dermis. In the face, most of the blood flow moves horizontally as opposed to the other regions of the body where the blood flow moves vertically up into the dermis from the fat. This important fact of lateral blood flow allows the performance of a face-lift by cutting completely around the ear and separating the tissue out toward the mouth and lower neck and temporal regions.
No matter in what layer the fact-lift is performed, once sufficient tissues have been freed, stretched and pulled back toward the ear, excess tissue is then cut out with scissors or scalpel. The first reason a face-lift is successful is that the deeper tissues and surface tissues are freed and the tissues are then affixed to each other or other structures in order to tighten the tissues below the surface and indirectly on the surface. Secondly, surface tightening occurs when the tissue edges that remain following the removal of tissue are cut and sewn around the ear. Thirdly, tissue tightening occurs because of the trauma that occurs to most tissues during the entire procedure.
Whenever trauma occurs to tissue, scar tissue or fibrosis tissue is created. Scar/fibrous tissues have contractile elements in them, similar to miniature muscles. The key is to create the proper damage so that fibrous-tissue tightening may occur, but destruction, full thickness loss of tissue and overt scarification does not occur.
Improvements to the appearance of the epidermis also has been accomplished by use of lasers. Traditional laser resurfacing involves application of a Carbon Dioxide Laser on the epidermis destroying the epidermis and displaying the outer surface of the dermis. Erbium Yag Lasers are also used to tighten the skin and destroy the surface but do not cause as much thermal damage as Carbon Dioxide Lasers.
In the laser resurfacing procedure, superficial, medium, and relatively deep destruction methods are used depending upon the amount of resurfacing that a patient needs. Patients with mild sun damage may use superficial laser resurfacing procedures because most of the damage is near the top surface of the skin. Therefore, a high degree of concentration and destruction is not required. Patients with moderate or severe sun damage require relatively deeper laser resurfacing procedures, chemical peels or dermabrasion.
Laser resurfacing works very similarly to chemical peel or dermabrasion in that the surface of the skin is destroyed and new collagen is created. Epidermal elements, which coat the very surface of the skin, arise out of the hair pores. Too much destruction of the skin and too much destruction in general may destroy the hair pores and the ability of the skin to repopulate itself at the surface, which may lead to scarring. Scar tissue is fibrous tissue. Fibrous tissue makes up the bulk of the dermis, which is the "leather layer" of the skin. Whenever scar tissue is formed, these tissues in general contract.
The concept of the current invention by resurfacing skin from the "inside-out" was developed because of the nature of contraction observed when the interior or underside of the dermis tissue is damaged or altered by laser. The current invention projects laser beams on the interior surface of the dermis, which is the surface of the dermis that usually adjoins the subcutaneous fat tissue. The laser energy causes scarring and consequent contraction of the dermis.
The best age of the patient population suited to this invention are those without tremendous excess lack skin that would need to be cut out and thrown away during a traditional face-lift procedure. Patients that would benefit from this type of approach generally would be between the ages of 35 and 55.